Medical Declaration For Ifma Athletes (Page 3 of 3) in pdf

MEDICAL DECLARATION FOR IFMA ATHLETES

DECLARATION OF NON PREGANCY

*THIS SECTION IS TO BE COMPLETED BY ALL FEMALE ATHLETES ONLY

1. DECLARATION OF NON PREGNANCY FOR FEMALE ATHLETES AGED 18 (EIGHTEEN) AND OVER

________________________________________________

_____/______/________

PLACE

DATE

NAME OF EVENT: ___________________________________________________________________________________________

I, ________________________________________________ , declare that I am not pregnant.

I understand the seriousness of this statement and accept full responsibility for it. In the event that this declaration is subsequently

shown to be inaccurate or false and I suffer from any related injury or damage during the Event, I on behalf of my heirs, executors and

administrators, waive and release any and all claims for damages I may have against IFMA (including its officials and employees), the

organisers of the Event (including the Local Organising Committee and/or the Host Federation) and the Competitions Venue owners for

such injury or damage.

________________________________________________

ATHLETE SIGNATURE

-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

1. DECLARATION OF NON PREGNANCY FOR FEMALE ATHLETES AGED UNDER 18 (EIGHTEEN)

________________________________________________

_____/______/________

PLACE

DATE

NAME OF EVENT: ___________________________________________________________________________________________

I, ________________________________________, am one of the parents/legal caretaker of _________________________________

(insert name of athlete)

and declare, on her behalf that she is not pregnant.

I understand the seriousness of this statement and accept full responsibility for it in the event that this declaration is subsequently

shown to be inaccurate or false and _________________________________ suffers any related injury or damage during the Event, I on

(insert name of athlete)

Behalf of _________________________________, her heirs executors and administrators, waive and release any and all claims for

(insert name of athlete)

Damages she may have against IFMA (including its officials and employees), the organisers of the Event (including the Local Organising

Committee and/or the Host Federation) and the Competitions Venue owners for such injury or damage.

________________________________________________

PARENT/GUARDIAN SIGNATURE

Page 3 of 3

Medical Declaration For Ifma Athletes Page 3

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